Healthcare Provider Details

I. General information

NPI: 1972582435
Provider Name (Legal Business Name): LEE C LANEY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 E MARKET ST
WARREN OH
44483
US

IV. Provider business mailing address

2701 NW HIGHWAY 101 APT 28
LINCOLN CITY OR
97367-4450
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-7215
  • Fax: 330-399-2411
Mailing address:
  • Phone: 765-271-1744
  • Fax: 541-418-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301046119
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: